Global Excel Management Inc., is a health insurance claims management company and provides assistance, medical case management, cost containment and claims services. GEM was a wholly owned subsidiary of Expert Travel Financial Security (ETFS) Inc until 2011. In 2011, etfs was sold to Royal & Sun Alliance (RSA) Canada. Global Excel is now a completely independent entity, although the company maintains a key client relationship with RSA.

The Problem:

Recent business opportunities at GEM make it evident that they will need to process even higher volumes of bills quickly and accurately. GEM needs to be super-efficient to satisfy client demands in new markets and to be competitive on pricing and quality with short turnaround times. In order to meet these demands, GEM explored the option to outsource the claims data capture. GEM management team decided that they would need an experienced partner that could rapidly provide knowledgeable and well skilled data capture team. They chose Inteq for this challenging task.

Our Approach:

Inteq team partnered with GEM team members to create process documentation, working arrangement model detailing the transition plan and SOPs. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met.

Data capture:

As requested by GEM, Inteq commenced with data capture of HCFA and UB claim forms using clients CAI and e-file applications, the keying conventions and standard operation procedures were received from GEM. Each day’s claims processing is returned complete by the time GEM employees report to work the next morning i.e. less than 24 hours TAT. The data capture service was extended to include white bills, self-paid bills, QT and other invoices over the period of 7 years that Inteq has been associated with GEM.

Benefits:

The results were dramatic.

• Enhanced and expanded management reporting and decision support capabilities.
• Improved turnaround time and being achieved consistently
• Reduced manpower requirements
• Improved accuracy levels

Global Excel Management Inc., is a health insurance claims management company and provides assistance, medical case management, cost containment and claims services. GEM was a wholly owned subsidiary of Expert Travel Financial Security (ETFS) Inc until 2011. In 2011, etfs was sold to Royal & Sun Alliance (RSA) Canada. Global Excel is now a completely independent entity, although the company maintains a key client relationship with RSA.

The Problem:

Recent business opportunities at GEM make it evident that they will need to process even higher volumes of bills quickly and accurately. GEM needs to be super-efficient to satisfy client demands in new markets and to be competitive on pricing and quality with short turnaround times. In order to meet these demands, GEM explored the option to outsource the claims assessment functions. In addition they also required assistance to better manage workflow peaks and valleys. The Complex structure of claims from across the world made it that much more challenging. They chose Inteq for this challenging task.

Our Approach:

Inteq team partnered with GEM team members to create process documentation, working arrangement model detailing the transition plan and SOPs. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. Inteq set up a two member transition team to go to client site for facilitation of transition of the claims assessment process. Activities undertaken onsite were process mapping, training and documentation. Inteq’s experience in managing Business Process Outsourcing (BPO) engagements made the claims administration process transition to offshore an immediate success.

Claims Assessment: 

During the onsite phase a number of activities were performed simultaneously offshore. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. The offshore launch and level one productivity and quality levels were achieved as per plan.

The process involves:

• Validation of claims in client’s software in accordance with the policies and rules pre-specified by the client
• Claims adjudication upon by the adjudicators who are well trained on taking decisions on health claims
• Auditing of claims adjudicated

Benefits:

The results were emphatic.

• Improved quality and processing time of claim administration functions
• Enhanced and expanded management reporting and decision support capabilities.
• Improved turnaround time and being achieved consistently
• In-depth process documentation
• Improved accuracy levels
• No backlogs

This timely and cost effective method of claims administration has allowed Inteq to consistently achieve our accuracy guarantee to GEM. The Company has engaged Inteq as their offshore partner for BPO services.

Global Excel Management Inc., is a health insurance claims management company and provides assistance, medical case management, cost containment and claims services. GEM was a wholly owned subsidiary of Expert Travel Financial Security (ETFS) Inc until 2011. In 2011, etfs was sold to Royal & Sun Alliance (RSA) Canada. Global Excel is now a completely independent entity, although the company maintains a key client relationship with RSA.

The Problem:

Recent business opportunities at GEM make it evident that they will need to process even higher volumes of bills quickly and accurately. To provide better services to corporate clients in terms of cost containment and to meet the requirements of insurance companies in North America with respect to receipt of Original bills GEM needed to have a team that could call providers. GEM management team decided that they would need an experienced partner that could rapidly provide knowledgeable and well skilled calling personnel. They chose Inteq for this association.

Our Approach:

Inteq team partnered with GEM team members to create process documentation, working arrangement model detailing the transition plan and SOPs. Offshore team began with a pilot assignment to ensure service levels and quality metrics would be met. Inteq’s experience in managing Business Process Outsourcing (BPO) engagements made the Provider Calling transition to offshore an immediate success.

Provider Calling: 

• Validation of providers in client’s software in accordance with the policies and rules pre-specified by the client.
• Providers are called and appropriate actions are requested for receipt of original bills.
• Auditing of calls for improving call experience.

Benefits:

The results were dramatic.

• Improved quality and processing time of provider calling functions.
• Improved turnaround time and being achieved consistently.
• Reduced manpower requirements.
• Improved accuracy levels.